Brock Haskell

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11856179-1206 Issued in UT

Practice address

11620 S State St Ste 1403
Draper, UT 84020-7124

Phone

(385) 302-7369

Fax

(385) 247-8023

NPI assigned

Apr 2, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Life Elevated Psychiatry LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Draper, UT
  • NPI 1063199305
  Medicare reassignment Authorized official
• Sergio Abarca, M.D., Inc

  • Family Medicine Physician
  • Tooele, UT
  • NPI 1770766586
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1821627746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11620 S STATE ST STE 1403",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207124",
            "telephone_number": "385-302-7369",
            "fax_number": "385-247-8023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11620 S STATE ST STE 1403",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207124",
            "telephone_number": "385-302-7369",
            "fax_number": "385-247-8023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2356 N 400 E Ste 201",
            "address_purpose": "LOCATION",
            "city": "Tooele",
            "state": "UT",
            "postal_code": "840743409",
            "country_code": "US",
            "telephone_number": "435-882-2350",
            "fax_number": "435-882-2039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HASKELL",
        "first_name": "BROCK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-02",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "57989",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "11856179-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua A Harward, MPT
• Kevin Thomas Harward, AU.D.
• Russell Val Harward Sr., DC
• Tracy Christopulos Harward, LMFT
• Dache Hasenberg
• Ashley Grover Hatch
• Traci Lyn Hatch
• Jacob Hatfield
• Sam Hawkes
• Camille Van Wagoner Hawkins, LCSW

• Physician Assistant in Draper, UT
• Providers in Draper, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.